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Most likely an autoimmune disease

Over the last couple of weeks, my husband and I have noticed Butters progressively having more trouble with chewing. At first, I thought he was just trying to swallow his treats too quickly, but he has been having increasing trouble with smaller and smaller treats over the last several days. Yesterday he started having difficulty swallowing water. We found him attempting to drink for several minutes, getting more water on his ears than in his mouth and drooling over his bowl. Needless to say, we made an emergency appointment with the vet.

On our visit to the vet today, Butters could not open his mouth for the exam. I have never had this difficulty with him before, but had noticed at home that he was getting more fussy with brushing his teeth. He also had 2 very swollen mandibular lymph nodes on either side of his neck. The vet pointed out that he has significant localized muscle atrophy around the jaw and temples, something that I had never noticed before. Looking at his pictures, it is difficult to really tell when that started.

He goes tomorrow for additional testing. The major consideration the vet initially had was focal myasthenia gravis. He is planned to have a chest x-ray, basic blood work, and an endoscopy (to look for megaesophagus vs foreign bodies or other possible pathology in the mouth/nose/esophagus) in the morning. However, looking further into his symptoms, I am increasingly worried that he may have masticatory muscle myositis (which Cavaliers are at increased risk for)... especially with the planned endoscopy (I have read that forced manual retraction of the jaw is contraindicated). This possible diagnosis did not come up during our visit today, but he really fits the picture. We plan to discuss this other possibility with the vet in the morning, and hope that we can come to the right diagnosis and treatment plan quickly.

My husband and I are right now absolutely feeling devastated. Butters is still his happy self at the moment, but watching him struggle when he goes to eat and drink is heartbreaking. He is trying so hard, and I can't help but sob watching him struggle. He is so young, at only 1.5 years, and my husband especially is having a rough time (this is his first dog, and they are inseparable).

I guess I am looking for anyone who has additional information/suggestions/feedback, particularly related to our situation and/or the potential diagnosis of MMM. I have read that having preexisting muscle atrophy is consistent with a chronic form, but his presentation otherwise really looks like an acute flair. He has never had symptoms like this before. Anyone have a similar situation, and did your cav improve? worry about the fact that the chronic form, most often identified by atrophy (with associated muscle fibrosis), has a worse prognosis with less likely improvement. What else should we think about discussing with our vet?

Also, we are most likely looking at a period of Butters being on high dose steroids (for MMM he would be on 2mg/kg to start, from my literature search)... and the side effects that go with them. Right now Butters sleeps on the bed. Since urinating in sleep can be an issue, should we start transitioning into a different arrangement? Should we arrange doggie diapers or a waterproof bed to lay on our comforter? What sorts of adjustments should we anticipate and plan for?

I am so sorry to read this about Butters. Words cannot express the sorrow that I feel for you and your hubby right now. My thoughts and prayers are with you.

I have never heard of the illness that you describe, let alone ever had experience of it with any of my Cavaliers, but I do have a couple of simple suggestions for helping with the giving of water. I think you should try experimenting with putting water into the side of Butters' mouth with either a dosing syringe which you can get from the vet, or if that is too difficult for him to cope with, then drop by drop around the gums with the kind of ear or eye dropper syringe will help.

If you are feeding kibble or biscuit, it might be helpful to soak it in water or gravy first, otherwise a moist tinned food, preferably one intended for puppies might help to keep his strength up, because I would imagine that Butters depletes his stamina and energy levels when he tries so hard to swallow food and water. Hand feeing in tiny amounts might help him too.

Perhaps somebody else here might have some experience of this problem. Others on similar lists may have relevant experience to share with you. If so, I will pleased to pass on anything helpful.

Oh...well you know both Mr. Monster and I are big Butters fans and I'm so sorry he is not feeling perfect. I can only guess what a worry this is. I cannot offer any advice however, just take it one step at a time. You did step one you took him to the vet ASAP now do everything you can to help figure this out...you are doing that. Try not to freak out yet you know what people say about webmd-ing yourself I know it just about impossible to NOT think the worst especially with our sweet cavaliers but try. As you said for now its pretty happy, try the trick for getting him water that Flo suggested. Please update us as you get more info. I hope someone in CT has some more info for you.

Melissa
"If you don't own a dog, at least one, there is not necessarily anything wrong with you, but there may be something wrong with your life."
-Roger Caras

I'm so sorry you're going through this. The only thing I can say is that it doesn't sound like megaesophagus. My brother's cavalier has this and she eats just fine but has to be held in an upright position for at least 20 minutes after eating or else everything comes right back up. I hope you have good specialists who will listen to you.

Regarding steroids, Riley started out on 10 mg prednisone a day for several weeks after her SM surgery and then cut back to 5 mg/day for several years, then down to 2.5 mg for about a year and we just weaned her to 1 mg/day. She has never urinated in her sleep and she sleeps in our bed with us also. In total, she's been on prednisone for over 4 years and has never peed in the house. That being said, years ago we had a german shepherd who couldn't tolerate steroids and would pee in the house with one dose of prednisone! I guess every dog is different.

... I guess I am looking for anyone who has additional information/suggestions/feedback, particularly related to our situation and/or the potential diagnosis of MMM. I have read that having preexisting muscle atrophy is consistent with a chronic form, but his presentation otherwise really looks like an acute flair. He has never had symptoms like this before. Anyone have a similar situation, and did your cav improve? worry about the fact that the chronic form, most often identified by atrophy (with associated muscle fibrosis), has a worse prognosis with less likely improvement. What else should we think about discussing with our vet? ...

It is a neuromuscular disease in which the muscles used by the dog to chew – the jaw and temporal muscles, which are called masticatory muscles – are inflamed, and it is painful and difficult or impossible for the dog to open its mouth. It is believed by researchers to be hereditary in the CKCS.

If my dog had it, I would consider alternative treatments by holistic vets.

Can't directly help at all, but I remember that we had a thread a few months ago on MMM, as someone had a Cavalier with it. Might be worth using the search facility to find it? Meanwhile, thinking of you

There are many threads about MMM - search for myositis. I've bumped three of them to the top - and there are links to information in some of these threads. You might also want to look at the thread about muscular dystrophy - which you'll also find when you search.

I've known of perhaps 25 cases in Cavaliers over the last 20 years or so; I'd say it is uncommon but the problem does exist in the breed.

My thoughts are with you as you seek a diagnosis and treatment plan. If you are in New York, you hopefully have access to specialists.